Breast Density: If I Had Only Known

JoAnn Pushkin

Breast Cancer Home / / November 08, 2016

In 2013, New York became the very first state to require women be informed of their own breast density after their mammograms. Unfortunately, my own story of a later-stage missed cancer was the inspiration. Though faithful to my mammography schedule, my cancer went undetected an estimated 5 years in a row hidden behind dense tissue. I discovered it during a self-exam. I was never told I had dense breasts, never told breast density drastically compromises the effectiveness of a mammogram, and, tragically, was never referred on for further screening which would have detected my cancer at an earlier stage.

Astoundingly, on the day my lump was so big I could feel it, it did not show up on a mammogram; it did, though, display clearly on an ultrasound. Since then I have devoted time to enacting legislation which requires women be provided information about their own breast density, and launch of a medically sourced, educational website DenseBreast-info.org. Below I share what I wish I had knownbefore my cancer diagnoses.

Breast Density Fast Facts:

Breast density is determined through a woman’s mammogram and described as one of four categories.

Dense breasts are normal. 40% of women age 40 and over have dense breasts.

Although normal, dense breast tissue is a risk factor for developing breast cancer and the denser the breast, the greater the risk.

Though mammograms pick up some cancers not seen on other screening tests, in dense breasts, cancers can be hidden on mammography and may go undetected until they are larger and more likely to have spread.

Other screening tests like ultrasound or MRI, in addition to mammography, substantially increase detection of early stage breast cancer in dense breasts.

Does insurance cover any additional screening?

The answer depends on the type of screening, your insurance, risk factors, the state you live in, and whether or not a law is in effect requiring insurance coverage for additional screening. In Illinois, for example, if ordered by your health care provider, a woman with dense breasts can receive an ultrasound without a copay or deductible. In Connecticut, an ultrasound co-pay for screening dense breasts cannot exceed $20. Generally, in other states, an ultrasound will be covered if ordered by your physician - but is subject to the copay and deductible of your individual health plan. In New Jersey, insurance coverage is provided for additional testing if a woman has extremely dense breasts.

NEWS! In 2017, New York will become the first state to provide full coverage (no copay / no deductible) for mammograms and follow-up breast screening or diagnostic imaging exams. The new law also expands the hours of operation of mammography facilities. Here are some details for ladies in the Big Apple:

The law goes into effect January 1, 2017

All plans on and off NY’s Exchange will cover, at no cost (no copay/no deductible), all mammography, supplemental screening and diagnostic imaging.

Open enrollment for NY Exchange begins November 1st for the 2017 plan year.

However, corporate plans set up as “self funded” or “self insured” (check with your company’s benefits manager), are not regulated by the State and are exempt from state insurance laws. This means they may still cover the tests, but copay and deductible will apply.

June 2016: Governor Cuomo signing the new expanded insurance law into effect.

JoAnn Pushkin, Executive Director of DenseBreast-info.org, is a patient/advocate, author and speaker. Her initiative and advocacy served as inspiration for New York State's breast density inform law which went into effect in January 2013. On the federal level, Ms. Pushkin led the efforts for both the introduction of the Federal Breast Density and Mammography Reporting Act, as well as the FDA’s Mammography Quality Standards Act regulatory amendment consideration.